state surveys tips

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i've never gone through the experience of being surveyed. any tips and advice? what kind of questions do they ask? will they expect everything to be perfect? i have 40 to 45 patients (depending on census) and i do everything from med pass to wound treatments. just thinking about it makes me sick to my stomach.:uhoh21:

State survey will make anyone sick. We just had ours and it was a nightmare. The team was horrible to us. They had attitude from the moment that they came in our front doors. I have been here for 5 years and have never experienced anything like this.

They will ask you anything they want. They ask about your policy et procedures. They will ask about your fire policy. They watch your med passes. They watch you do certain treatments. They can pull in the STNAs and watch them do pericare on people. One of the surveyors on our Alzheimers Unit released a lapbelt and then hung around to see how long it took for someone to notice and put it back on. They dig in the patients charts and check your orders, admission paperwork, dietary notes, nurses notes, MARS/TARS, immunization records, care plans, PCP notes. You name it, they look at it. They will also look for expired meds, insulins, ect when you are doing your med pass. I am not sure about every states policy but ours is the insulin expires 28 days after being opened. (or at least that is our pharmacy policy)

Here are some tips for surviving:

1. You will not always have the answer they need. Don't tell them "I don't know." Tell them, "I'll find out for you and get back with you." It goes much better that way.
2. I like to have a Drug Book on my cart while passing meds. If they ask me something about a med, it is ready to check for them should I not know off the top of my head.
3. Don't offer them any info they do not ask. Just give them the specific thing they ask for and offer nothing more.
4. Be sure that you lock your cart when you walk away from it, unless it is in eye site. But I still always lock it just to be safe.
5. Don't leave any meds on top of your cart. Insulins are ok around my part.
6. Monitor your staff and make sure everyone is wearing gloves when appropriate.
7. Remember residents privacy. No shots out in commons areas. No acuchecks out there either. Actually here you are not supposed to give meds in them at all.

I know some of these things are back to the basics but there is always someone here that does some of these things and gets caught. I always feel like I am back in school and have an instructor watching me. Just remember they are no better of a nurse than you are just because of the position they are in. You are their equal. You will make it through. Good luck!!:spin:

Last time I went through state survey, they had several patients pre-selected which they asked many questions about, and asked to see treatments on. They were patients that had stage 4 wounds, or certain infections, like c-diff and MRSA. I found them to be pretty straightforward, not trying to catch us doing anything wrong, just making sure we knew the basic correct principles.

A week ago, I worked thru my agency at a facility undergoing survey. Because
I work nights, luckily I did not encounter them, but could have. I heard that they
were very hard on the staff, and this was in a very well run LTC.

A very experienced RN supervisor gave me some tips about passing meds in front of them should they appear during our 6am med pass.

Always cover your med kardex with a piece of paper or otherwise not leave it open to view to ensure privacy. Never leave any meds out on the cart, and she specifically including insulins. If you have to crush any meds, give each one separately. Do not mix them together. (Nevermind that they are all going to the same place!). If giving meds via GT, flush with whatever the amount says in your kardex before and after giving each med. Again, do not mix them together.

Here's a little story about what happened during this inspection just last week . One of the
long term patients was a retired RN who worked for years in LTC. She hates
state inspectors having had to deal with them in her work. She reported that she saw one of the male inspectors switch the little cards that are on patients meal trays that tell what diet and consistency each patient is supposed to get, to see if any of the staff would notice. They did, but what if it was a new staff member that did not know these patients? Scarey. Too me this is a little dangerous, and should not be legal for them to do, as was the case in another post about releasing a lap belt on a patient with Alzheimers. JMO.

I was told that inspectors focus on the care that the CNAs give, and in particular, the Alzheimer Units. If you look like you know what you are doing, they won't pick you out. Of course, it is hard to look nonchalent with them around...

Good luck. I am sure that you will be fine. Most nurses do survive this.

lol!! ok, here is my state survey story! i had been in school, and hadn't worked in 4 months. i received a call from work asking if i could fill in on a shift the next day. it just so happened that my schedule allowed me to do so. so, imagine my surprise when i show up at 6am, happy and excited to see everyone again and receiving the news that state has made a surprise visit, and will be in the facility the next few days!!
all in all, it wasn't bad. the only thing the surveyor said after watching me pass meds to 3 patients, is that 1 of the patients neurontin was due at 7am and i gave it at 8:50am, outside the 1 hour b4, 1 hour after rule. she explained that its important to keep those levels up and consistent in this patient.

so, for me, it was a great learning experience.....i doubt it will be like that everytime though!!

I've had many experiences with inspectors, but the most memorable was this one fellow, he sat down on the floor in the tv room in front of a female pt and was trying to see If she had underwear on under her dress. I'm sure she did cause I can't remember any problems like that from the survey, but that is too weird, another lady accused the nurse ot taking her purse and she had actually left it some where else.
Some have been decent but I get sick when ever I here "There here".
Glad I don't do that anymore.

Here's a little story about what happened during this inspection. One of the
long term patients was a retired RN who worked for years in LTC. She hates
state inspectors having had to deal with them in her work. She reported that she saw one of the male inspectors switch the little cards that are on patients meal trays that tell what diet and consistency each patient is supposed to get, to see if any of the staff would notice. They did, but what if it was a new staff member that did not know these patients? Scarey. Too me this is a little dangerous, and should not be legal for them to do, as was the case in another post about releasing a lap belt on a patient with Alzheimers. JMO.

That IS dangerous for them to be able to do that, What if that patient gets up and falls? Who is going to be held responsible?

So what........they can't find something wrong so they're going to make incidents so something WILL be wrong? That is just totally unfair.

Most surveyors haven't had a real nursing job in years and could NEVER do what they expect us to do. I've had all kinds of them. The past few years they have been exceptionally nasty....one of them lied outright to one of the corporate people who happened to be in the building at the time.
My survey is due any day now...all 3 of the nursing managers, myself included, have been in the building for less than 2 months. We are working like crazy to fix what we can before survey.
What do I do when the surveyors are there? Pray pray pray!

i don't know why people get their panties in a twist over surveys unless they have something to hide. a survey is a physical inspection to see if a facility and its employees are following the state and federal laws as well as the facility's own policies and procedures. if people are worried it must be because they know they are not following laws and rules or they are cutting corners, don't you think? one of the laws is the law under which our license to practice is granted, so you have to follow good nursing practice. you can view the federal laws governing ltc here on this website:

if you've never actually read them before, take some time to look them over. they are not that hard to read or understand. your facility policies and procedures should have these laws incorporated into them. you'll have to find your state laws that pertain to ltc. the website of your state department of health might have links to them since they are usually the agency that enforces the state laws for nursing facilities.

as part of your preparation, read through the facility policy and procedure book. all of the employees should be following your own policies and procedures. telling a surveyor, "but we always do it this way", is going to get the facility in trouble if it deviates from the written policy. if the surveyors have questions, the laws and/or the facility policy and procedure book is where they will go to see if you gave the correct answer. you should also know your facility policy regarding fire and other emergencies. make sure your drug carts are clean and organized. i used to empty a couple of drawers from the med cart now and then and soak them in hot water to get the sticky gunk out of the crevices. get rid of outdated and discontinued medications. spruce up and clean the medication room and nurses station. dirt and dust of any kind doesn't look good. if these things are being done periodically anyway, it won't be such a big deal. bad attitudes work in both directions. you'll get as good as you receive. i've been with surveyors who were absolutely wonderful and great sources of information. if a surveyor seems cranky, don't take it personally. these people live in motels during the week when they are surveying in an area away from where they live. surveyors have a responsibility to teach as well as evaluate, so if you have any burning questions make a list. they hold an informational session with the employees after the survey is completed where you can talk with them and get answers. if you want to pick their brains about how you can improve the way you do some nursing practice, ask them. they survey many facilities and have seen hundreds of different ways nursing tasks are accomplished. they are in the unique position of being able to tell you what they've seen that works better than something else. many of the nurse surveyors on these survey teams were dons or nursing instructors before they became surveyors.

"Surveyors have a responsibility to teach as well as evaluate, so if
you have any burning questions make a list. They hold an
informational session with the employees after the survey is completed where you
can talk with them and get answers. If you want to pick their brains
about how you can improve the way you do some nursing practice, ask them."

In all my years in long term care, the teaching has NEVER happened. One of them said to me "I am not here to teach you anything....you should already know these things".

In all my years in long term care, the teaching has NEVER happened. One of them said to me "I am not here to teach you anything....you should already know these things".

One crabby surveyor shouldn't be held accountable for the whole group. That's not fair. But it is true that we are supposed to already know basics. But, if you want information and suggestions about things like how other facilities organize their med passes or get all their resident showers done by the day shift, ask them to share what they have seen and observed. They shouldn't deny sharing that with you. If they do, complain about that at the end meetings. Or, write a letter of complaint to their supervisors. If these are state surveyors they are paid out of state taxes that we all pay to support what they do. They serve the public of which we are a part. Remind them of it. If they are from JCAHO your facility pays a fee for the services JCAHO provides to them. These group meetings that are held with the facility staff are done for a reason. Make them earn their salary. They can't cite a facility for employees who ask questions in an effort to improve their practice.

State survey will make anyone sick. We just had ours and it was a nightmare. The team was horrible to us. They had attitude from the moment that they came in our front doors. I have been here for 5 years and have never experienced anything like this.

They will ask you anything they want. They ask about your policy et procedures. They will ask about your fire policy. They watch your med passes. They watch you do certain treatments. They can pull in the STNAs and watch them do pericare on people. One of the surveyors on our Alzheimers Unit released a lapbelt and then hung around to see how long it took for someone to notice and put it back on. They dig in the patients charts and check your orders, admission paperwork, dietary notes, nurses notes, MARS/TARS, immunization records, care plans, PCP notes. You name it, they look at it. They will also look for expired meds, insulins, ect when you are doing your med pass. I am not sure about every states policy but ours is the insulin expires 28 days after being opened. (or at least that is our pharmacy policy)

Here are some tips for surviving:

1. You will not always have the answer they need. Don't tell them "I don't know." Tell them, "I'll find out for you and get back with you." It goes much better that way.
2. I like to have a Drug Book on my cart while passing meds. If they ask me something about a med, it is ready to check for them should I not know off the top of my head.
3. Don't offer them any info they do not ask. Just give them the specific thing they ask for and offer nothing more.
4. Be sure that you lock your cart when you walk away from it, unless it is in eye site. But I still always lock it just to be safe.
5. Don't leave any meds on top of your cart. Insulins are ok around my part.
6. Monitor your staff and make sure everyone is wearing gloves when appropriate.
7. Remember residents privacy. No shots out in commons areas. No acuchecks out there either. Actually here you are not supposed to give meds in them at all.

I know some of these things are back to the basics but there is always someone here that does some of these things and gets caught. I always feel like I am back in school and have an instructor watching me. Just remember they are no better of a nurse than you are just because of the position they are in. You are their equal. You will make it through. Good luck!!:spin:

Leslie

Make sure you use handcleaner every time after giving meds (unless you know you are not contaminated) and wash your hands every 5th time after giving meds)

i've never gone through the experience of being surveyed. any tips and advice? what kind of questions do they ask? will they expect everything to be perfect? i have 40 to 45 patients (depending on census) and i do everything from med pass to wound treatments. just thinking about it makes me sick to my stomach.:uhoh21:

Take your 802 and highlight the above areas vertically all the way down the bottom of the page. Then highlight the names of residents who have any of these items. The residents who have several of these items are more likely to be picked for review.

Make sure preassessments are done. These include restraint, falls, smoking, self administration of meds, and side rails,etc. Any resident who is self medicating should have meds locked up in their room if that is where the meds are stored. Some system should be in effect for the resident to record with an "x" or whatever on a calendar when they take their meds. Then the med nurse must still ask the resident if the meds are taken and then record on the MAR.
Every quarter this process must be assessed (sooner if problems) and addressed. The facility is still responsible for the resident getting their meds and adequate assessment and followup.

Make sure items with "keep out of reach of children "are locked up in the bathing areas and all other areas. If these items are in the residents rooms and used for personal items, they should be out of sight. If you have wanderers then you'll need to reassess keeping them unlocked in the residents rooms.
Frequently check the linen carts for these items. The carers tend to "hide" these items for easy access. These would probably be baby powder, hand wash items, personal cleansers, etc.

Make sure wheelchairs are clean. Dining is a great time to assess this issue.

Make sure all residents have the needed assistance for dining. Make sure residents who need cuuing are given the needed reminding.

Make sure all residents are at the appropriate table height. Also residents should be taken from their wheel chairs (if possible) and seated in chairs. Dietary should always rotate the serving of food so the same residents are not always served last.